What is the use of Provera (Medroxyprogesterone acetate)?

From the Guidelines

Provera, or medroxyprogesterone acetate, should be used with caution and at the lowest effective dose for the shortest possible time, considering its potential risks and benefits, particularly in the context of hormone replacement therapy 1.

Key Considerations

• Provera is a synthetic form of the hormone progesterone, commonly prescribed for conditions like abnormal uterine bleeding, amenorrhea, endometriosis, and as part of hormone replacement therapy.
• The typical dosage ranges from 2.5 mg to 10 mg daily, depending on the condition being treated, and it's often given for 5-10 days to induce withdrawal bleeding in cases of menstrual disorders.
• Side effects may include breast tenderness, headaches, mood changes, and fluid retention.
• Patients with a history of blood clots, liver disease, breast cancer, or unexplained vaginal bleeding should discuss these conditions with their healthcare provider before taking Provera, as it may be contraindicated in these situations.

Evidence-Based Recommendations

• The most recent and highest quality study, from 2021, suggests that medroxyprogesterone acetate (MPA) is effective in inducing secretory endometrium together with a full replacement dose of estrogen when used regularly 1.
• However, MPA may negatively impact cardiovascular risk, and alternative progestins like natural micronized progesterone may have a more favorable profile 1.
• The US Preventive Services Task Force recommends against the use of hormone therapy for the primary prevention of chronic conditions in postmenopausal women, except for the treatment of menopausal symptoms 1.

Clinical Implications

• Clinicians should choose between a sequential and continuous regimen of administration, with the latter preventing withdrawal bleeding, and the dose of progestogen should be based on the concurrent dose of estrogen administered 1.
• Patients should be informed about the potential risks and benefits of Provera, particularly in the context of hormone replacement therapy, and the decision to initiate or continue therapy should be made on a case-by-case basis, considering individual risk factors and medical history.

From the FDA Drug Label

The suspension is intended for intramuscular administration only. Endometrial or renal carcinoma— doses of 400 mg to 1000 mg of DEPO-PROVERA Sterile Aqueous Suspension per week are recommended initially.

• Medroxyprogesterone acetate is not recommended as primary therapy, but as adjunctive and palliative treatment in advanced inoperable cases including those with recurrent or metastatic disease.
• The recommended dose is 400 mg to 1000 mg per week initially, which may be reduced to 400 mg per month if improvement is noted 2.

From the Research

Provera Overview

• Provera, also known as medroxyprogesterone acetate (MPA), is a highly effective contraceptive with a very low failure rate comparable to modern copper IUDs and lower than many other methods 3.
• It is given as 150 mg by deep intramuscular injection every 12 calendar weeks (84 days+5 days) and is independent of intercourse and user memory, making it a great advantage for many women 3.

Non-Contraceptive Uses

• MPA has been used to manage endometriosis, with studies showing improvement or remission in all cases, even though breakthrough bleeding occurred in some patients 4.
• Hormone therapy with estrogen, including MPA, is used to manage menopausal symptoms, with systemic estrogen alone or combined with a progestogen reducing the frequency of vasomotor symptoms by approximately 75% 5.
• MPA has also been used in hormone replacement therapy for women with endometriosis in post-surgical menopause, although the evidence is not strong enough to suggest depriving severely symptomatic patients from this treatment 6.

Safety and Efficacy

• Long-term clinical experience has established the safety of Depo-Provera, with benefits and risks of hormonal therapy being well-established 7.
• Common patient management issues, including effects on menstrual cycle, body weight, and mood, are addressed in the literature, with recommendations for appropriate patient selection 7.
• The use of local protocols to allow nurse administration of Depo-Provera is supported, both in general practice and the clinic situation 3.